Innovations ‘Out of Place’: Controversies Over IVF Beginnings in India Between 1978 and 2005

ABSTRACT

In 1978, the year the first in vitro fertilization (IVF) baby was born in the United Kingdom, a research team in Kolkata reported that it too had successfully produced an IVF baby in India. However, the claim was dismissed at the time, because the experiment was conducted outside authorized institutions and recognized centers of innovation—in short, because it was an innovation ‘out of place.’ Tracing controversies over the case between 1978 and 2005, I show the importance of space or place in processes of knowledge production and recognition. Further, I explain the initial repudiation and subsequent partial recognition of the claim through shifts in the landscape of legitimate spaces of innovation. By discussing this specific case of the production of science and technology in the Global South, I challenge conventional narratives of diffusion that are prevalent in studies on the worldwide proliferation of reproductive technologies.     

Patient-provider communication before and after implementation of the contraceptive decision support tool My Birth Control

ObjectiveTo compare differences in patient-provider communication among patients who, prior to contraceptive counseling, used or did not use a decision support tool (“My Birth Control”) which has educational and interactive modules and produces a provider printout with the patient’s preferences.MethodsAs part of a cluster-randomized trial of the tool in four San Francisco safety net clinics, we collected and thematically analyzed 70 audio recordings of counseling visits (31 pre- and 39 post-tool implementation) from 15 providers randomized to the intervention.ResultsWithout the tool, most providers began by asking participants what method they were considering and focused counseling on that method or on directing patients towards long-acting reversible contraception; with the tool, most focused on reviewing and discussing multiple methods of interest to the participant as indicated on the printout. Discussion of patients’ preferences for specific method features was not observed in pre-implementation recordings but was part of several post-implementation recordings. Several participants explicitly noted they had gained knowledge from the tool.ConclusionObserved counseling differences suggest the tool may have a positive impact on patient-centeredness of contraceptive counseling, consistent with findings from the main study.Practice implicationsMy Birth Control shows potential for improving patient-centeredness in counseling without extensive provider training.     

伤口评估卡片联合电子照片在老年科护士伤口专科知识培训中的应用

[目的]探讨伤口评估卡片联合电子照片在老年科护士伤口专科知识培训中的应用效果。[方法]按照随机数字表法将老年科60名护士分为观察组和对照组各30例,对照组采用电子照片对护士伤口专科知识进行培训和指导,观察组采用自制伤口评估卡片联合电子照片对护士伤口专科知识进行培训和指导。比较两组护士伤口专科知识的掌握程度、护士记录伤口病人护理文书的记录质量及护士对伤口病人伤口转归的护理管理能力。[结果]观察组护士伤口专科知识的掌握程度、护士记录伤口病人护理文书的记录质量及护士对伤口病人伤口转归的护理管理能力均优于对照组(P<0.05)。[结论]在老年科护士伤口专科知识培训中应用伤口评估卡片联合电子照片效果显著。     

Knowledge about the impact of age on fertility: a brief review

Delayed childbearing is currently a major challenge in reproductive medicine as increased age has an important impact on successful conception, both in natural and in assisted reproduction. There is a lack of knowledge about the impact of age on fertility, even in highly educated populations. A number of initiatives have been taken to increase fertility awareness. Health care providers have been encouraged to talk with patients about their reproductive life plan (RLP) for almost a decade based on recommendations from the Centres for Disease Control and Prevention. This concept has been explored successfully in Swedish contraception counselling. A growing number of online interventions aim to raise fertility awareness. These websites or interactive tools provide relevant information for individuals and couples as they consider whether they want children, when they should have them, and how many they may wish to have. These interventions are important, because research depicts that knowledge helps people in their decision-making process. With new fertility preservations such as egg freezing now available, additional education is needed to be sure that women and couples are well informed about the cost and low success rates of this intervention.     

Knowledge,attitudes, and practices regarding seasonal influenza vaccination during pregnancy in Costa Rica: A mixed-methods study

BackgroundInfluenza increases stillbirth risk, morbidity and mortality in pregnant women. Vaccination protects pregnant women against severe disease and indirectly protects their infants, but coverage among pregnant women remains low worldwide. We aimed to describe knowledge, attitudes, and practices (KAP) regarding seasonal influenza vaccination among postpartum women and prenatal care physicians in Costa Rica.MethodsWe conducted cross-sectional KAP surveys to women one to three days after childbirth at Costa Rican Social Security Fund maternity hospitals, and obstetricians and general practitioners who provided prenatal care in 2017. Principal components analysis, multiple imputation, and logistic regression were used to examine associations between influenza vaccination and demographics, prenatal care, and sources of information—separately for postpartum women and physicians. We also held two focus groups of six healthcare workers each to further describe vaccination KAP.ResultsWe surveyed 642 postpartum women and 146 physicians in maternity hospitals in five Costa Rican provinces of whom 85.5 % (95 % CI: 82.6 %-88.0 %) and 57.9 % (95 % CI: 49.6 %-65.7 %) were vaccinated for influenza, respectively. Factors associated with influenza vaccination for postpartum women included tetanus vaccination (aOR: 3.62, 95 % CI: 1.89–6.92); received vaccination recommendations from clinicians during prenatal check-ups (aOR: 3.39, 95 % CI: 2.06–5.59); had other children in household vaccinated for influenza (aOR: 2.25, 95 % CI: 1.08–4.68); and secondary/university education (aOR: 0.15–0.31) with no formal education as reference. For postpartum women, reasons for vaccination were perceived benefits for mother and infant, whereas not being offered vaccines was most cited for non-vaccination. Most prenatal care physicians recommended influenza vaccines during prenatal check-ups but believed vaccination causes flu-like symptoms.ConclusionVaccination campaigns and provisions of free vaccines effectively increased knowledge and coverage among women in Costa Rica. To improve access, women should be offered vaccines during prenatal care appointments. Educating healthcare workers about vaccine benefits for themselves and patients is needed to mitigate safety concerns.     

东莞市12岁儿童口腔健康知识认知与相关行为调查

目的了解东莞市12岁儿童口腔健康知识、行为现状,为东莞市口腔卫生保健工作提供信息支持。方法于2018年6—7月采用分层随机整群抽样方法,抽取东莞市12个镇(街道)3014名12岁儿童进行口腔健康行为问卷调查。结果96.15%的12岁儿童每天都有刷牙,其中每天刷牙≥2次的儿童所占比例为57.07%,男生和女生间有统计学差异(χ2=46.05,P<0.01);含氟牙膏的使用率仅为6.90%;84.97%的12岁儿童了解“吃糖可以导致龋齿”,65.30%的12岁儿童知道“刷牙时牙龈出血不正常”,但知道牙菌斑概念的儿童比例仅为15.63%。结论东莞市儿童口腔健康状况和行为有待改善,在继续大力推广窝沟封闭预防龋齿措施的同时,应加强儿童口腔保健知识,特别是有效刷牙的宣传教育,促进儿童建立健康口腔行为。     

Social medicine,feminism and the politics of population: From transnational knowledge networks to national social movements in Brazil and Mexico

ABSTRACT

This article examines the role of national actors articulated with an explicitly counter-hegemonic transnational knowledge network (TKN) mobilising around social medicine in policy debates on population control and family planning. It focuses primarily on Brazil, using Mexico as a shadow case to highlight salient points of contrast. In doing so, it makes two contributions to larger debates about TKNs. First, it highlights the plural and contested nature of the knowledge production they enact, underscoring contestation around a global reproductive regime that consolidated around family planning. Second, it underscores how the position and relative influence of actors articulated with TKNs is shaped by political and institutional contexts at the national level, producing variable opportunities for the mobilisation of applied knowledge. Reflecting its advocates’ embeddedness in larger opposition movements to authoritarian states, social medicine had a greater influence on these debates in Brazil, where synergies with a resurgent feminist movement reinforced a shared insistence on comprehensive women’s healthcare and increased the salience of sterilisation abuse on the political agenda.     

Examining the contraceptive decisions of young,HIV-infected women: A qualitative study

This study qualitatively examined factors that influenced contraceptive choices in a sample of young, HIV-infected women. Individual qualitative interviews were conducted among 30 vertically and horizontally HIV-infected women (n = 26 African American) from the ages of 14 to 24 years (Mean age = 20.9 years). We recruited sample groups with the following characteristics: (a) current contraceptive/condom use with ≥1 child (n = 11); (b) current contraceptive/condom use with no children (n = 12); and (c) no current contraceptive/condom use with no children (n = 7). A semi-structured interview guide was used to ask participants about factors influencing past and current contraceptive choices. Individual interviews were digitally recorded and transcribed verbatim; analyses to identify core themes were informed by the Grounded Theoretical approach. Young, HIV-infected women did not identify their HIV serostatus or disease-related concerns as influential in their contraceptive decisions. However, they reported that recommendations from health-care providers and input from family and friends influenced their contraceptive choices. They also considered a particular method’s advantages (e.g., menstrual cycle improvements) and disadvantages (e.g., increased pill burden) when selecting a method. Findings suggested that HIV-infected young women’s contraceptive decisions were influenced by factors other than those related to their infection.